With new nCoV case in Chicago, US says no travel to Wuhan

Travelers at O'Hare Airport
Travelers at O'Hare Airport

Thomas Hawk / Flickr cc

A woman from Chicago who traveled to Wuhan, China, at the end of December and returned on Jan 13 represents the second travel-related case of novel coronavirus (2019-nCoV) infection diagnosed in the United States, according to officials from the Illinois Department of Public Health (IDPH) and the Centers for Disease Control and Prevention (CDC).

The CDC also announced that 63 suspected cases of 2019-nCoV are under investigation in 22 states, while 11 people have tested negative for the novel coronavirus, while 2 have been confirmed. On Jan 21, the CDC said a man in Washington state had contracted the disease.

Developments in the fast-evolving outbreak prompted US officials to step up travel restrictions to Wuhan, which is the epicenter of an outbreak that has topped 900 cases.

In addition, yesterday Texas A&M University confirmed that a student was being tested for 2019-nCoV and placed in isolation while awaiting test results. The student had recently traveled to Wuhan.

"We are expecting more cases in the US, likely to see cases of human-to-human transmission," said Nancy Messonnier, MD, director of the CDC's National Center for Immunization and Respiratory Diseases.

Patient has mostly stayed home

Allison Arwady, MD, MPH, Chicago's public health commissioner, said the Chicago case involves a Chicago resident in her mid-60s. She is doing well and is in stable condition, Arwady said, but remains hospitalized in isolation for infection control purposes in an unnamed Chicago-area hospital.

The woman was asymptomatic and did not have a fever upon her return from Wuhan but developed symptoms within a week of coming home. She alerted her clinician to her travel history in Wuhan.

"We know that the woman did not ride public transportation, and did not attend any large public gatherings," said Arwady, who added that the woman's limited interactions meant the risk to Chicagoans was low. Arwady also said the woman did not travel to Wuhan with any other Chicago or Illinois residents.

"She had limited movements outside her home," she said. All close contacts are currently being monitored and feeling well," Arwady said.

CDC calls for self-monitoring

Like the first travel-related case-patient, the Chicago woman was not symptomatic during travel, which is both encouraging and discouraging to the CDC.

On one hand, Messonnier said that early evidence suggests the coronavirus is most transmissible when patients are symptomatic. But asymptomatic travelers are not caught via airport screening methods, said Martin Cetron, MD, director for quarantine and migration at the CDC.

"This is why we need to rely on self-monitoring," Cetron said. "We need people who have traveled to Wuhan to be looking for symptoms for 14 days, and calling ahead to their physician if they think they have been exposed."

Chinese officials have banned air and rail travel in and out of Wuhan and Hubei province this week, but some patients may have already traveled out of the region before developing symptoms.

The CDC said, despite the Chinese travel bans, it will use enhanced surveillance in five US airports that have heavy air travel to and from China: Los Angeles International, Chicago O'Hare, Hartsfield-Jackson in Atlanta, JFK in New York City, and San Francisco International.

"We have screened over 2,000 folks, 200 flights; we have not found any cases," said Cetron.

Messonnier also said the CDC is working to get rapid diagnostic kits to states that are most likely to see cases of 2019-nCoV. Currently, all testing in the US is done at the CDC in Atlanta.

State Department, CDC up travel warnings

Yesterday the US Department of State placed the highest travel restrictions (level 4) on Wuhan and Hubei province, saying no US citizen should travel to the region.

"On January 23, 2020, the Department of State ordered the departure of all non-emergency U.S. personnel and their family members," the State Department said. "The U.S. government has limited ability to provide emergency services to U.S. citizens in Hubei province."

If travel is essential, US residents should avoid animal markets, avoid contact with sick people, and practice hand hygiene. If a US resident develops respiratory illness within 14 days of travel from Wuhan, the State Department said they should seek medical care and call ahead to hospitals and clinics to warn physicians of their recent travel.

The CDC issued a Level 3 travel alert, which says all non-essential travel to Wuhan should be avoided.

See also:

Jan 24 CDC news release

CDC 2019-nCoV page

Jan 23 Texas A&M press release

Jan 24 US Department of State site on China travel

Jan 23 CDC travel site

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